Adenosine, Cardioprotection and Its Clinical Application


Book Description

The immense growth in the number of articles on adenosine cardioprotection in recent years has been related in large part to the hypothesis that adenosine plays a role in ischemic preconditioning. Ischemic preconditioning is the phenomenon in which a brief period of ischemia (and reperfusion) prior to a more prolonged occlusion reduces myocardial infarct size. This form of myocardial protection has received much interest because ischemic preconditioning has been shown to be the most potent means of reducing infarct size in all animal models so far tested. Within the last six years, the principal focus of adenosine cardioprotection research has centered on the role of adenosine receptors. It is currently thought that adenosine protects the ischemic heart primarily via the activation of adenosine A1 receptors located on the cardiac myocytes. Adenosine is used clinically for terminating supraventricular tachycardia, and as a diagnostic tool in coronary imaging, and has been used postoperatively for blood pressure control after heart surgery. There are also recent reports that adenosine may be safely tolerated and a potentially beneficial additive to cardioplegic solutions during open heart surgery in humans. There is even evidence that ischemic preconditioning may occur in humans under various clinical situations. This volume contains chapters from contributors to the first three symposia on 'Adenosine, Cardioprotection, and its Clinical Application'. All aspects of adenosine cardioprotection and ischemic preconditioning, including potential mechanisms and clinical applications, are discussed by experts in these areas. The reader will find this book to be an excellent source of information on these topics, as well as a guide to future experiments.




Caffeine in Food and Dietary Supplements


Book Description

Caffeine in Food and Dietary Supplements is the summary of a workshop convened by the Institute of Medicine in August 2013 to review the available science on safe levels of caffeine consumption in foods, beverages, and dietary supplements and to identify data gaps. Scientists with expertise in food safety, nutrition, pharmacology, psychology, toxicology, and related disciplines; medical professionals with pediatric and adult patient experience in cardiology, neurology, and psychiatry; public health professionals; food industry representatives; regulatory experts; and consumer advocates discussed the safety of caffeine in food and dietary supplements, including, but not limited to, caffeinated beverage products, and identified data gaps. Caffeine, a central nervous stimulant, is arguably the most frequently ingested pharmacologically active substance in the world. Occurring naturally in more than 60 plants, including coffee beans, tea leaves, cola nuts and cocoa pods, caffeine has been part of innumerable cultures for centuries. But the caffeine-in-food landscape is changing. There are an array of new caffeine-containing energy products, from waffles to sunflower seeds, jelly beans to syrup, even bottled water, entering the marketplace. Years of scientific research have shown that moderate consumption by healthy adults of products containing naturally-occurring caffeine is not associated with adverse health effects. The changing caffeine landscape raises concerns about safety and whether any of these new products might be targeting populations not normally associated with caffeine consumption, namely children and adolescents, and whether caffeine poses a greater health risk to those populations than it does for healthy adults. This report delineates vulnerable populations who may be at risk from caffeine exposure; describes caffeine exposure and risk of cardiovascular and other health effects on vulnerable populations, including additive effects with other ingredients and effects related to pre-existing conditions; explores safe caffeine exposure levels for general and vulnerable populations; and identifies data gaps on caffeine stimulant effects.




Coronary Microvascular Dysfunction


Book Description

In the past two decades a number of studies have shown that abnormalities in the function and structure of coronary microcirculation can be detected in several cardiovascular diseases. On the basis of the clinical setting in which it occurs, coronary microvascular dysfunction (CMD) can be classified into four types: CMD in the absence of any other cardiac disease; CMD in myocardial diseases; CMD in obstructive epicardial coronary artery disease; and iatrogenic CMD. In some instances CMD represents an epiphenomenon, whereas in others it represents an important marker of risk or may contribute to the pathogenesis of myocardial ischemia, thus becoming a possible therapeutic target. This book provides an update on coronary physiology and a systematic assessment of microvascular abnormalities in cardiovascular diseases, in the hope that it will assist clinicians in prevention, detection and management of CMD in their everyday activity.




Myocardial Protection


Book Description

Myocardial protection is regarded as one of the most important, yet also most controversial aspects of cardiac surgery. There has been considerable improvement in myocardial protection strategies over recent years, utilising a variety of new approaches to treat cardiac diseases, and this text is intended to embrace the state of the art in this field. The book summarises the state of knowledge on all aspects of myocardial protection, including the latest in the treatment of cardiac diseases, robotics, pediatric surgery and the treatment of cardiac failure. Robotic surgery, valvular surgery, pediatric surgery and coronary surgery are all covered by renowned experts, producing a comprehensive, forward-looking view of the field of myocardial protection. This book should function to update physicians and surgeons interested in the field of cardiac surgery on the current state of knowledge on myocardial protection.




Coronary Pressure


Book Description

Cardiologists must answer three important questions when evaluating and treating patients with a coronary artery stenosis. As a physiologist: "What is the effect of this stenosis on coronary blood flow and myocardial function?"; as a clinician: " Is this lesion responsible for the patient's symptoms?"; and finally as an interventionalist: "Will revascularization of this artery improve the patient?" Fundamentally, the answer to these questions can be given to a large extent by measuring coronary pressure. That is the rationale of writing this book. 1. 1 Historical overview. Andreas Gruentzig and most interventional cardiologists in the early days of PTCA, had the intuitive feeling that pressure measurements could help to establish the severity of a coronary stenosis and to monitor the progress and result of a coronary intervention. At that time, measuring coronary pressure by the balloon catheter was part of a standard procedure. A residual transstenotic gradient of less than 15 mmHg was generally considered as a good result. Later, however, it turned out that measuring these (resting) gradients with balloon catheters was inaccurate an only had a limited prognostic value. Moreover, because there was no consistent theory to correlate pressure measurements to blood flow, the interest in measuring coronary pressures faded and disappeared almost completely with the introduction of new balloon catheters not intended for pressure measurement.




Adenosine Receptors in Health and Disease


Book Description

Since their discovery approximately 25 years ago, adenosine receptors have now emerged as important novel molecular targets in disease and drug discovery. These proteins play important roles in the entire spectrum of disease from inflammation to immune suppression. Because of their expression on a number of different cell types and in a number of different organ systems they play important roles in specific diseases, including asthma, rheumatoid arthritis, Parkinson’s disease, multiple sclerosis, Alzheimer’s disease, heart disease, stroke, cancer, sepsis, and obesity. As a result of intense investigations into understanding the molecular structures and pharmacology of these proteins, new molecules have been synthesized that have high specificity for these proteins and are now entering clinical trials. These molecules will define the next new classes of drugs for a number of diseases with unmet medical needs.




Cellular and Molecular Pathobiology of Cardiovascular Disease


Book Description

Cellular and Molecular Pathobiology of Cardiovascular Disease focuses on the pathophysiology of common cardiovascular disease in the context of its underlying mechanisms and molecular biology. This book has been developed from the editors' experiences teaching an advanced cardiovascular pathology course for PhD trainees in the biomedical sciences, and trainees in cardiology, pathology, public health, and veterinary medicine. No other single text-reference combines clinical cardiology and cardiovascular pathology with enough molecular content for graduate students in both biomedical research and clinical departments. The text is complemented and supported by a rich variety of photomicrographs, diagrams of molecular relationships, and tables. It is uniquely useful to a wide audience of graduate students and post-doctoral fellows in areas from pathology to physiology, genetics, pharmacology, and more, as well as medical residents in pathology, laboratory medicine, internal medicine, cardiovascular surgery, and cardiology. - Explains how to identify cardiovascular pathologies and compare with normal physiology to aid research - Gives concise explanations of key issues and background reading suggestions - Covers molecular bases of diseases for better understanding of molecular events that precede or accompany the development of pathology




Cardioprotection


Book Description

Coronary heart disease (CHD) is the leading cause of death worldwide. Cardioprotection refers to the prevention of CHD and the clinical improvement in patients suffering from cardiovascular problems.




Ischemic Preconditioning: The Concept of Endogenous Cardioprotection


Book Description

Ischemic Preconditioning: The Concept of Endogenous Cardioprotection consolidates, in one volume, both current knowledge and the most recent advances in ischemic preconditioning. The editors have invited investigators at the forefront of ongoing research to provide their scholarly and candid comments concerning each of these issues. This volume includes a comprehensive review of infarct size reduction with ischemic preconditioning, and the most recent data on the effects of preconditioning on ischemia and reperfusion-induced arrhythmias, myocardial metabolism, contractile function, and the coronary vasculature. The role of altered energy metabolism, stress-induced proteins, ATP-sensitive potassium channels, and adenosine -- the major hypotheses that have been proposed to explain the cardioprotective effects of ischemic preconditioning -- are critically reviewed by investigators who have been instrumental in developing these concepts. In addition, the editors raise the intriguing possibility that ischemic preconditioning may be more than simply a laboratory curiosity. Using a multidisciplinary approach, this volume challenges the readers to contribute their own expertise to address the unanswered questions concerning this endogenous, cardioprotective phenomenon.




Social System Accounts


Book Description

Non-Invasive Imaging of Atherosclerosis is a primer, reference and review of some of the key features of current activities in the field of atherosclerosis. The Editors' goal is to provide material and stimulating ideas to basic scientists and clinical researchers in order to extend the application of vascular imaging and to further develop methods suitable for investigation of the arterial wall. The first section presents current knowledge about pathology, vascular mechanics and compensatory mechanisms active during atherogenesis. It explores the early lesion, complications of plaques and early detection of plaques. Section II reviews several key methodological issues of B-mode ultrasound imaging and some of the most current data. Quantitative B-mode ultrasound is an established non-invasive tool widely used in large epidemiologic studies and interventional clinical trials of atherosclerosis. The last section addresses the most promising areas of development in vascular imaging. This involves new techniques to evaluate the atherosclerotic bed, to follow atheroma progression/regression and to evaluate vascular mechanics in atherosclerotic arteries. The last chapter places the application of non-invasive imaging in perspective.